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The lives of four physicians of the past are described, focusing on their unique contributions to the early development of neurosurgery in the United States and Canada. Each influenced the others during these formative years, and each played a major role in the evolution of a new surgical subspecialty.
Thrombin is an essential component of the coagulation cascade and forms immediately in the brain after an intracerebral hemorrhage (ICH). This chapter discusses the evidence concerning the role of thrombin in secondary brain injury following ICH. Thrombin enhances the synthesis and secretion of nerve growth factor in glial cells, modulates neurite outgrowth, and reverses process-bearing stellate astrocytes to epithelial like astrocytes. Thrombin also stimulates astrocyte proliferation and modulates the cytoskeleton of endothelial cells. The effects of thrombin in the brain are modulated by endogenous serine protease inhibitors. Thrombin is responsible for early brain edema development after ICH. Intracerebral injection of thrombin induces brain edema. Modulating thrombin activity in the brain may establish novel therapeutic strategies for ICH. However, because of the dichotomy in the effects of thrombin on brain injury, it is essential to delineate the pathways involved in the deleterious and beneficial effects of thrombin on brain injury.